Job Description
Primary point of contact for assigned healthcare providers and provider groups. This role is responsible for maintaining strong provider relationships, resolving operational issues, supporting network initiatives, and ensuring effective communication between providers and internal teams. The ideal candidate has experience in provider relations, managed care, or health insurance and possesses a strong understanding of Medicare.
Responsibilities
• Serve as the primary contact for assigned provider groups and physician practices.
• Educate providers on network processes, reimbursement updates, organizational initiatives, and Medicare-related requirements.
• Investigate provider concerns and coordinate resolution with internal teams.
• Support provider contracting and network implementation activities.
• Gather provider feedback and share insights with internal stakeholders.
• Analyze provider performance and operational trends to identify improvement opportunities.
• Represent the organization in provider meetings and industry events.
• Maintain knowledge of Medicare, reimbursement methodologies, provider network operations, and healthcare regulations.
Required Qualifications
• Bachelor's degree in Business, Healthcare Administration, Public Health, or a related field, or equivalent experience.
• 3-5 years of experience in healthcare, managed care, health insurance, provider relations, or physician practice management.
• Experience working directly with healthcare providers, physician practices, hospitals, or healthcare organizations.
• Excellent problem-solving, organizational, and project coordination skills.
• Ability to manage multiple priorities independently.
• Proficiency with Microsoft Office Suite.
• Knowledge of Medicare Advantage, Medicaid, CMS regulations, and HIPAA.
Preferred Qualifications
• Experience in provider relations, provider contracting, network management, or provider engagement.
• Experience with reimbursement methodologies, value-based care, or provider payment models.
• Experience leading presentations, training sessions, or provider education efforts.
• Project management or process improvement experience.
• Experience using data and analytics to support provider performance improvement.
Responsibilities
• Serve as the primary contact for assigned provider groups and physician practices.
• Educate providers on network processes, reimbursement updates, organizational initiatives, and Medicare-related requirements.
• Investigate provider concerns and coordinate resolution with internal teams.
• Support provider contracting and network implementation activities.
• Gather provider feedback and share insights with internal stakeholders.
• Analyze provider performance and operational trends to identify improvement opportunities.
• Represent the organization in provider meetings and industry events.
• Maintain knowledge of Medicare, reimbursement methodologies, provider network operations, and healthcare regulations.
Required Qualifications
• Bachelor's degree in Business, Healthcare Administration, Public Health, or a related field, or equivalent experience.
• 3-5 years of experience in healthcare, managed care, health insurance, provider relations, or physician practice management.
• Experience working directly with healthcare providers, physician practices, hospitals, or healthcare organizations.
• Excellent problem-solving, organizational, and project coordination skills.
• Ability to manage multiple priorities independently.
• Proficiency with Microsoft Office Suite.
• Knowledge of Medicare Advantage, Medicaid, CMS regulations, and HIPAA.
Preferred Qualifications
• Experience in provider relations, provider contracting, network management, or provider engagement.
• Experience with reimbursement methodologies, value-based care, or provider payment models.
• Experience leading presentations, training sessions, or provider education efforts.
• Project management or process improvement experience.
• Experience using data and analytics to support provider performance improvement.
Additional Details
Experience: 2-5 years